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HomeMy WebLinkAboutBuilding Permit #634-2017 - 730 WINTER STREET 12/12/201671A s Sc A�w °✓ .,. Ii BUILDING PERMIT I� TOWN OF NORTH ANDOVER i APPLICATION FOR PLAN EXAMINATION11Ls „ Permit NO: (93 N - l� Date Received I )L' 1 r}0 (V 4 . # Date Issued: 131 11 �- 1 4 --et, lr - � IMPORTANT: Applicant must complete all items on this LOCATION 730 Winter Street, North Andover, MA 01845 Print PROPERTY OWNER Matthew Norton Print MAP NO: 1046 PARCEL: 89 ZONING DISTRICT: R Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building CKOne family ❑ Addition ❑ Two or more family ❑ Industrial IXAlteration No. of units: ❑ Commercial ❑ Others: ❑ Repair, replacement ❑ Assessory Bldg ❑ Demolition ❑ Other P. Septic ❑ Well ❑. Floodplain C Wetlands E Watershed District P. Water/Sewer Basement area was previously finished but demolished due to moisture issues Work to include re -framing of non -load baring interior basement partition walls with metal studs, exterior facing walls insulation to R-15, sheet rock finish of walls and ceiling, finished trim, and painting. Install carbon monixide/smoke detector in finished area. Verify adequate makeup air for furnace operation. Identification Please Type or Print Clearly) OWNER: Name: Matthew Norton Phone: 978 844 0565 R caress: iau vvinter Street, North Andover, MA 01845 CONTRACTOR Name: Matthew Norton Phone: 978 844 0565 Address: 730 Winter Street, North Andover, MA 01845 Supervisor's Construction License: CS -104716 Exp. Date: 09/23/18 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER NA Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 5,500 FEE: $ 66.00 Check No.: _ g�," Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund re of ,iyowner / !�' na ure of contractor b ' 041 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: EVRORTANT: Applicant must complete all items on this pa -7� (D 6ATr I —57- rint PR 6P 5 RT-,Y,,i(DWN E-R�. :7 DNYeas PARC DISTRICT:] Historic ist ZONING T. Q i MA Ei Lt�Oe a— he j, lyesno yes he illage_ V __e§i no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family 0 Addition Ei Two or more family El Industrial El Alteration No. of units: [I Commercial El Repair, replacement Ej Assessory Bldg El Others: [I Demolition El Other Septic 11 VVetlo Floodplain s* El, F , lodd p i8ih Wet e�(" WH rs'fi6d"b1strh6-t u� Watershed wi�wut .0 7 -P aiO DESUKIF I IUN UI- VVUMM i u or- rr-nrur%uwiF-Lj- Identification - Please Type or Print Clearly OWNER: Name: A-J -J -- - - - Pho ARCHITECTIENGINEE Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT., $12-00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. (.'--,rotal Project Cost: $ FEE: $ Check No.: Receipt No" NOTE: P-eAsons contracting with unregistered contractors do not have: access to the guaranty fund- e'. enitl6Wher e of contractor; w r- Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TypF OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art t [� Swimming pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Sianature COMMENTS HEALTH t COMMENTS Reviewed on Sianature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street ,Fires Department signatureldate t: COMMENTS limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop.Z."requires approval of Electrical Inspector Yes No ®ANDER Z®NE LItKAJUKE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine No Doc.Building Permit Revised 2014 17., / 1 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.i.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (if Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan • Photo of H.I.C. And C.S.L. Licenses • Workers Comp Affidavit • Two Sets of Building Plans (One To Be Returned) to include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit in all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording must be submitted with the building application i Doc: Building Permit Revised 2014 Location --T'�O wff14rit No.. k -sq- at) 7 Date I; TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL $ Check oso Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 53500.00 m $ - $ 66.00 Plumbing Fee $ 8.25 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 8.25 Total fees collected $ 182.50 730 Winter Stree 634-2017 on 12/12/2016 Basement I rl J Q W u=. p O m v U Y O LL E O U, }, 0. N O0 W a Z Q Z .:m C 0O C O t h0 O of v Ct U LL W N Z Z J 0. to O w — LL O W Ln Z V u J W t CA O d' v In LL CC V a Z Q C7 L h0— M. K LL Z CWC G a W p LLI °� _ LL c L m Z �+ UJ v0 Ln 0 N Y Ln N -'j 16 < 0 V► G0P AQ' O* 4no O r cc) 9 O Cc O a� Q � o w -�Ec a� L �' a 34q""'—o +- E a, �o� �L �N `m > _ • � L = O y N O a) to 0 O = c � U U)Q Q. _ E. c 0 3 CL L N CL ouCA..� mo :V=-00) Q COD � ns CL ai H 0 N O 2co Cc m LU = -0+�-� O O li y to = 'o. t o w E `O' 0 •� i U Q O O w N N -0 o c O F- t - 0-00 JE r= 4 [�W O O` : r LU Z C7 z 0 M CO za Z � Lu 0- x x z w0 U W LU z ti O 2 v v O E z AN W .E CDa.CD O v a U) .CL U) V ca U) lw Gerald A. Brown Inspector of Buildings Please print DATE: 12-08-2016 TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION JOB LOCATION: 730 Winter Street 1046 89 Telephone (978) 688-9545 Fax (978)688-9542 Number Street Address Map/Lot HOMEOWNER Matthew Norton (978) 844-0565 (978) 278-3399 Name Home Phone Work Phone PRESENT MAILING ADDRESS 730 Winter Street North Andover City Town MA State 01845 Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 M 4-- r4 C C m . c� 4-- r4 A U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY Nalionol Flood fn.vru-ance Program Important: Read the instructions on pages 1--9. OMB No. 1660--0008 Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al, Building Owner's Name AMY E: BRENNAN REVOCABLE TRUST 2010 o icy a er: A2. Building Street Address (including Apt„ Unit, Suite, and/or Bldg, No.) or P.O, Route and Box No, ,Company NAIC Number,' 730 WINTER STREET City NORTH ANDOVER State MA -LIP Code 01845 A3. Property Description ([-at and Block Numbers; Tax Parcel Number, legal Description, etc.) LOT 1 ON PLAN N0: 7588 OF 1977 A4, Building Use (e,g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDEN;T'IAI_ A5, I-atitude/Longitude: I_at, 42"41'01.997" Long, .71°03'25.374" Horizontal Datum: ❑ NAI) 192.7 M NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 2 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 0 sq i't a) Square footage of attached garage 6 sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosures) within 1.0 foot above adjacent grade 11 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8 -b 0 sq ;n c) Total net area of flood openings in A9,b Q sq in d) Engineered flood openings? F Yes G� No d) Engineered flood openings? F1 Yes (� No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name ,& Community Number B2 County Name, E33 tat Se W NORTH ANDOVfER 2.50098 NORI"HERN ESSEX MASSACHUS:E'S !I 134. Map/Panel Number 135. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Flevation(s) (lone 0241 F JULY 3, 2012 f_ffE ctive./Rovised Date Zone(s) A0, use base flood depth) JULY 3; 2012 A NONE 1:310, Indicate the source of the Base Flood IDevation (BFE) data or base flood depth entered in Item B9, C_I FIS Profile tk1 FIRM El Community Determined I_l Other/Source: 1:311, Indicate elevation datum used for BFE in Item 139: tj NGVD 192.9 fel NAVD 1988 I_l Other/Source: 1:312., Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? r_j Yes 0 No Designation Date: _ (_] CBRS L..l OPA SECTION C - BUILDING (ELEVATION INFORMATION (SURVEY REQUIRED) C1, Building elevations are based on: E] Construction Drawings` f.=1 Building Under Construction" G9 finished Construction "A new elevation Certificate will be required when construction of the building is complete:. 02, I-levations -- Zones Al -A30, AE", Al -i, A (with BFQ, VE, V1 --V30, V (with BFE), AR, AR/A, AR/At-H, AR/Al-A30, AR/AH, AR/AQ. Complete Items C2.a-h below according to the building diagram specified in Item A7, In Puerto Rico only, enter meters, Benchmark Utilized: GPS Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below, L-1 NGVD 1929 [q NAVD 1988 ❑ Other/Source: . Datum used for building elevations must be the same as that used for the BFE, Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the: building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) I-lighest adjacent (finished) grade next to building (MAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 137.46 ( zf feet [_I meters 144.44 LA feet C:I meters NA. ❑ feet EI meters 143;82 N feet EI meters 137,81 [ feet meters 141,03 feet CJ meters 143.83 feet ❑ meters 142,91 ® feet [ meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION 'T'his certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to cerl;ify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available.. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S: Code, Section 1001, [ j Check here if comments are provided on back of form_ Were latitude and longitude in Section A provided by a ❑ Check here if attachments, licensed land surveyor? ® Yes El No Certifier's Name GEORGh EDWARD SMI'T'H III — - - � License Number 38718 v Title PLS Company Name NEW ENGLAND LAND SURVEY, INC. Address25 SU I'"1'ON AVE. NUE SUITE= 4 City OXFORD State MA ZIP Code 01540 Date 2/25/2014 Telephone 508-987••0025 Iff PROFIESStONAL FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions, ---EVATION CERTIFICATE, page 2 1PORTANT: In these spaces, copy the corresponding information from Section A. wilding Street Address (including Apt., Unit, Suite, and/or l3ldg. No.) or P.O. Route and Box No FOR INSURANCE COMPANY USE 30 WIN-rER STREET Policy Number: City NORTH ANDOVER State MA ZIP Code 01845 Company NAIC Number: SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this L--levation Certificate for (1) community official, (2)JIISUrance agent/company, and (3) building owner, Comments NONE.--------._----__-�- Sig Ila tLire ' Date 2/25/2014 SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without 13FE), complete Items E1• -SES, if the Certificate is intended to support a LOMA or L.OMR,F request, complete Sections A, R, and C For Items E=1 -•E4, use natural grade, if availablE Check the measurement used; In Puerto Rico only, enter meters, F?1 Provide elevation information for the following and chr cic the appropriate boxes to show whether the elevation is above or below the lr g ,grade (FIAG) and the lowest adjacent grade (LAG). hest. adjacent a) lop of bottom floor (including basement, crawlspace, or enclosure) is 6.37 (XJ feet EJ meters [J above or jj<J below the I IAG,. b) l"op of boltont floor (including basert?ent, crasllsp ce,.o enclosure) ,;; 3,3 j rC; feat (� meters LJ abovo or F below Clic LA{.. F2. I or 13wldintt Diagrams 6-9 With permanent flood openings provided in ectron A items 8 and/or 9 (see pages 8-9 of Instrucrtionsj, tile next I. igllo�-floor (elevation 2.b In-tho diagrams) offhe building is 01,61_ rA feet [I meters above`ph [�),beliiw the HAG t a. llCtacherl garago (top Of stab) is 0.01 [xj foot [jl ilnetors ll above or R_ below file HAG. te4. Top of platform of machinery and/or equipment servicing the building r5 CE O??_ feet (� meters ILL) above or 9 below the l-1AG. E:6. Tone nc only: If lto flood depth number i ordinancs available, i& the lot) of the bottorn floor elevated in accordance with the community's floodplain Management e? EJ yes (j No jXJ Unknown,'1The local official must certify this information in Section G, SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION 1110 property owner or owners aulhonzed representative who completes Sections A, f3, and I --- for Z..onc n (without a f=E::Mn,issued Of community -issue) or Zone AO must sign here. 'I Ile siate'llents in Sections n, t3, slid /.arra correct to the best of my krtowledg,e. Property Owner's or Owner's Authorir_ed Representative's Name �- Address City State _ - _ Zlf Coda �ir,nature Date "1"elephonc Continents _-----•__-�- SECTION G -- COMMUNITY INFORMATJON (OPTIONAL) _ v -- The local ofirciatl who 1s authorir�d I>y law ctr ordinance tci administer the. cenintunity's i7oUdplain ntana jdsment iai•tlinartio can complete Sections n, t3. Cor €» n of ih�s Eaevaliort Certifioade. Corttpietoahe applicable ilem(s) and sign below, Check the measr;femenl used in Hems GBG j0, In -Puerto itietionly, enter mete and G G1 (�I Tito infprrtiation in Section C was taken from vtftei documentation that has been signed aHyl sealed by a licensed sttn+cyor, enginecai, ar architect who Is atrtborired by law to cert:iiy elevation informafion, (Indicate lite source_and date of Elie elevation data in tii�i Comtngnts area bolgtiv.j G?, CI n community official canpleted Section i_ for a building located in Zone A (without a FFMA-issued or community -issued 13FEi) or Zone AO, G3, j=;1 The following information (items G4 -G10) is provided for Community floodplain management purposes. 6,4 Permit Number "— G5, hate Permit Issued — _-- _- - -_ •- ._—.,.- - `G6. Date Certificate Of Goirtp@attr e1C)ccupancy Issued G% This permit has been issued for: [; New Construction' „� L] Substantial Improvement 08. E"levation of as -built lowest floor (including basement) of the building:- - feetmeters Datum [._) meters Datum G9, E1I-L or (in Zone AO) depth of flooding at the building site: `--" C'10. Community's design flood elevation: CJ feet [�j � --'- _ E.] feet 0 meters Datum I,ocal Official's Name - -- ------ - ---- - -- -•- - -- - --- Title Community Name _ --- Telephone Signature --.----__ Date Comments -_ -- -- _._—_---, C1eck here if attachments. IA -'MA Fnrm nRR-n-3't r711 ?t ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Boz No, Policy Number: 730 WINTER STREET City NORTH ANDOVER State MA "LIP Code 01845� Company NAIC Nunitier. If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View," When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. FRONT VIEW 2/22/2014 RIGHT SIDE VIEW 2222/2014 REAR VIEW 2/22/2014 FRONT VIEW 2/22/7014 T FEAR VIEW W22/2014 LEFT SIDE V[SW 2222/2014 FEMA Form 086-0-33 (7/12) Replaces all previous editions. lay 6 F_, sa L '�.Nd a4 .4it LEFT SIDE V[SW 2222/2014 FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No,) or R0, Route and Box No. 730 WINTER STREET City NORTH ANDOVER State MA ZIP Code 01845 FOR INSURANCE COMPANY USE l f'aticy N�n�be"r; ��� Company NAIC Number: If submitting more photographs than will fit on therecedin •— p g page, affix the additional photographs below, Identify all photographs with: date taken; "f=ront View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8, 4 I-1=AAA C-- noc, n oo i7mg1 Page 1 of 2 Date: April 24, 2014 Case No.: 14.01-1694A LOMA QF,4ARTyF a Federal Emergency Management Agency 0F� Washington, D.C. 20472 ND SEL LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT REMOVAL COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF NORTH ANDOVER, Lot 1, as described in the Quitclaim Deed, recorded as Document ESSEX COUNTY, No. 26482, in Book 12682, Pages 145,146 and 147, in the Office of MASSACHUSETTS the Registry of Deeds, Essex County, Massachusetts COMMUNITY COMMUNITY NO.: 250098 NUMBER:25009CO241F AFFECTED MAP PANEL DATE: 7/3/2012 FLOODING SOURCE: FISH BROOK APPROXIMATE LATITUDE & LONGITUDE OF PROPERTY: 42.684, -71.057 SOURCE OF LAT & LONG: ARCGIS 10.1 DATUM: NAD 83 DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST WHAT IS CHANCE ADJACENT LOT LOT BLOCK/ SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION SECTION THE SFHA ZONE ELEVATION ELEVATION (NAVD 88) NAVD 88) (NAVD 88 1 -- -- 730 Winter Street Structure X — 141.0 feet — (unshaded) Special Flood Hazard Area (SFHA) - The SFHA is an area that would be inundated by the flood having a 1 -percent chance of being equaled or exceeded in anv given vear (base flood). ADDITIONAL CONSIDERATIONS (Please refer to the appropriate section on Attachment 1 for the additional considerations listed below.) PORTIONS REMAIN IN THE SFHA ZONE A STUDY UNDERWAY This document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment for the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined that the structure(s) on the property(ies) is/are not located in the SFHA, an area inundated by the flood having a 1 -percent chance of being equaled or exceeded in any given year (base flood). This document amends the effective NFIP map to remove the subject property from the SFHA located on the effective NFIP map; therefore, the Federal mandatory flood insurance requirement does not apply. However, the lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred Risk Policy (PRP) is available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed. This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877 -FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, LOMC Clearinghouse, 847 South Pickett Street, Alexandria, VA 22304-4605. Luis Rodriguez, P.E., Chief Engineering Management Branch Federal Insurance and Mitigation Administration Page,i of 2 Date: April 24, 2014 Case No.: 14.01-1694A LOMA • VAR FAY a Federal Emergency Management Agency 3� Washington, D.C. 20472 �qND SQL LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS) PORTIONS OF THE PROPERTY REMAIN IN THE SFHA (This Additional Consideration applies to the preceding 1 Property.) Portions of this property, but not the subject of the Determination/Comment document, may remain in the Special Flood Hazard Area. Therefore, any future construction or substantial improvement on the property remains subject to Federal, State/Commonwealth, and local regulations for floodplain management. ZONE A (This Additional Consideration applies to the preceding 1 Property.) The National Flood Insurance Program map affecting this property depicts a Special Flood Hazard Area that was determined using the best flood hazard data available to FEMA, but without performing a detailed engineering analysis. The flood elevation used to make this determination is based on approximate methods and has not been formalized through the standard process for establishing base flood elevations published in the Flood Insurance Study. This flood elevation is subject to change. STUDY UNDERWAY (This Additional Consideration applies to all properties in the LOMA DETERMINATION DOCUMENT (REMOVAL)) This determination is based on the flood data presently available. However, the Federal Emergency Management Agency is currently revising the National Flood Insurance Program (NFIP) map for the community. New flood data could be generated that may affect this property. When the new NFIP map is issued it will supersede this determination. The Federal requirement for the purchase of flood insurance will then be based on the newly revised NFIP map. This attachment provides additional information regarding this request. If you have any questions about this attachment, please contact the FEMA Map Assistance Center toll free at (877) 336-2627(877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, LOMC Clearinghouse, 847 South Pickett Street, Alexandria, VA 22304-4605. Luis Rodriguez, P.E., Chief Engineering Management Branch Federal Insurance and Mitigation Administration 1 i Info mation and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if -you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia The Commonwealth of Massachusetts k9l.Department of IndustrialAceidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib1Y Name (Business/organization/Individual): Matthew Norton Address: 730 Winter Street City/State/Zip: North Andover, MA 01845 Are you an employer? Check the appropriate box: Phone #: (978) 844-0565 1.❑ I am a employer with employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3.® I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. © Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees, If the sub -contractors have employees, they must provide their workers' comp. policy number. I ani an employer that is providing ivw'kers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lia #:. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains anApenalties of perjury that the information provided above is trite and correct Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: j Massachusetts Department of Public Safety Board of Building Regulations and Standards IV License: CS -104716 Construction Supervisor 1 MATTHEW D NORTON i 730 WINTER STREET!,) NORTH ANDOVER MA 01846`- CA I n, , Expiration: Commissioner 0912312018